Medicaid Coordinator - Full Time Days - Immanuel Pathways Southwest Iowa at Immanuel in Council Bluffs, Iowa

Job Description:

The purpose of this job is to ensure that participants receive and maintain their Medicaid eligibility, which includes tracking and processing reviews/renewals annually. Responsibilities include assisting current participants in maintaining Medicaid benefits through the yearly review/renewal and managing Share of Cost or Client Participation requirements with participants. Responsible for working with Accounting and Executive Directors in notification and follow up for Share of Cost, and Client Participation per state Medicaid notification. Supports and lives out Immanuel's Mission and CHRIST'S Promises.

Approx. Time Requirement

Key (Essential) Functions of this Job

80% Medicaid Eligibility Processes

• Reviews Medicaid eligibility, monitors time frame for review/renewal and takes necessary steps to complete review/renewals to prevent Medicaid closure.


• Educates participants on the Medicaid application, review/renewal process and general rules/regulations.


• Assists participant with gathering financial documentation.


• Establishes and maintains relationships with state Medicaid resources.


• Identify and explain Medicaid issues to participants and coordinates resolutions, if applicable.


• Effectively communicates with Income Maintenance workers in the State of Iowa and the Social Service Worker in the State of Nebraska, regarding Medicaid.


• Maintain knowledge of current and emerging information regarding Immanuel Pathways, Medicaid, Medicaid legislation, regulations, and trends and disseminate and educate Immanuel Pathways managers and staff.


• Assists in developing procedures and defining and improving best practices regarding Medicaid eligibility for Immanuel Pathway Center participants.


• Participates in quarterly meetings with State Administrating Agency and Immanuel Pathway Centers, or as needed.


• Maintains Medicaid tracking through software system to ensure timely review/renewals of Medicaid for no case closure.


• Provides complete documentation within software system regarding Medicaid, i.e. uploaded documents, narration of discussions, and updated review/renewal dates.


• Manages all follow-up with participants and collaborates with Accounting and Executive Director regarding past due Share of Cost, Client Participation.


• Creates pending disenrollment letter/involuntary disenrollment to be executed and followed up by the Executive Director.


• Manages all discussions with, and assists participant and authorized representative regarding Medicaid Eligibility, Share of Cost, Client Participation, Miller Trust (Iowa Centers), Estate Recovery and past due processes as requested by the Executive Director.


• Provides timely communication of Medicaid status change to Immanuel Pathway Centers, Accounting, and Risk Adjustment Analyst.


• Travels to Immanuel Pathway Centers in Iowa/Nebraska to complete job responsibilities on a weekly or as needed basis.


• In Nebraska, will establish a calendar for contact with the assigned Social Worker during the first week of the month and on the 2 nd to last working day of the month regarding new enrollees and disenrollments.


• Assists participants and family, in coordination with the Enrollment Coordinator, to keep resources within guidelines for Medicaid eligibility.

• Support PACE Provider Network Manager with network development and maintenance needs such as tracking, research and other administrative support as requested.


• Support PACE Provider Network Manager with Assisted Living and Skilled Nursing Facility relationship building and administrative support as requested.

• Provides consultation to center Social Workers as needed regarding PACE participant financial resources, budgeting and impact to ongoing Medicaid eligibility throughout the year.


• Provides consultation to center Enrollment Coordinators as needed on Medicaid eligibility questions associated with PACE potential enrollees.


• Collects data and prepares reports at the direction of the Director of PACE Business Operations.


• Participates and supports the Quality Improvement Initiatives.


• Practices Universal Precautions and follows appropriate infection control procedures.


• Protects privacy and maintains confidentiality of all company procedures, results, and information about employees, participants, and families.


• Performs related duties as required or requested.

• Some college is required.


• Bachelor's Degree in Business, Accounting/Finance, Marketing, Social Work or a related field is preferred.


• Equivalent years of experience may substitute for education requirement.

• Two (2) years of experience in assisting individuals who are applying for Medicaid or other governmental programs is required.


• One (1) year of experience working with the frail or elderly population required, or completion of job specific training related to working with the elderly population must be completed within the first six months of hire.


• Experience in healthcare setting is desirable.

• Agree to abide by the philosophy, practices, and protocols of the Immanuel Pathways (PACE) organization.


• Must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.


• Must have a valid driver's license, proof of insurance and have means of reliable transportation for driving to Immanuel Pathway Center locations.


• Speaking and interpreting different languages is desirable.

• Knowledge of Medicaid regulations, processes and procedures.


• Knowledge of or the ability to learn the PACE philosophy and eligibility/denial criteria.


• Knowledge of financing mechanisms such as Medicaid, Medicare, Prospective Payment systems, and Health Maintenance Organizations or other managed care systems providing risk-based capitated rates.


• Knowledge of computer applications including Outlook, Word, Excel, data base software.


• Ability to meet deadlines, complete projects, and manage multiple tasks.


• Ability to follow naming conventions and practices as established.


• Skills in organizing time and prioritizing duties.


• Skills in effective written and verbal communication.


• Skills in establishing and maintaining effective working relationships with participants, co-workers, and the public.


• Skills in follow-up and follow through with people and appointments.


• Ability to project professionalism, approachability, and genuine interest to various audiences.


• Ability to work independently with minimum supervision.


• Ability to identify roadblocks and offer solutions.


• Ability to work under deadline situations.


• Ability to work within various software and document management systems.


• Able to offer feedback and positively resolve conflict.


• Ability to internalize and apply feedback from manager/supervisor to improve performance and minimize errors.

• Some college is required.


• Bachelor's Degree in Business, Accounting/Finance, Marketing, Social Work or a related field is preferred.


• Equivalent years of experience may substitute for education requirement.

• Two (2) years of experience in assisting individuals who are applying for Medicaid or other governmental programs is required.


• One (1) year of experience working with the frail or elderly population required, or completion of job specific training related to working with the elderly population must be completed within the first six months of hire.


• Experience in healthcare setting is desirable.

• Agree to abide by the philosophy, practices, and protocols of the Immanuel Pathways (PACE) organization.


• Must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.


• Must have a valid driver's license, proof of insurance and have means of reliable transportation for driving to Immanuel Pathway Center locations.


• Speaking and interpreting different languages is desirable.

• Knowledge of Medicaid regulations, processes and procedures.


• Knowledge of or the ability to learn the PACE philosophy and eligibility/denial criteria.


• Knowledge of financing mechanisms such as Medicaid, Medicare, Prospective Payment systems, and Health Maintenance Organizations or other managed care systems providing risk-based capitated rates.


• Knowledge of computer applications including Outlook, Word, Excel, data base software.


• Ability to meet deadlines, complete projects, and manage multiple tasks.


• Ability to follow naming conventions and practices as established.


• Skills in organizing time and prioritizing duties.


• Skills in effective written and verbal communication.


• Skills in establishing and maintaining effective working relationships with participants, co-workers, and the public.


• Skills in follow-up and follow through with people and appointments.


• Ability to project professionalism, approachability, and genuine interest to various audiences.


• Ability to work independently with minimum supervision.


• Ability to identify roadblocks and offer solutions.


• Ability to work under deadline situations.


• Ability to work within various software and document management systems.


• Able to offer feedback and positively resolve conflict.


• Ability to internalize and apply feedback from manager/supervisor to improve performance and minimize errors.